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Diagnosis of tuberculosis in South African children with a T-cell-based assay: a prospective cohort study

Susan Liebeschuetz1, Sheila Bamber, Katie Ewer

  • 1Ngwelezana Hospital, Empangeni, kwaZulu-Natal, South Africa.

Lancet (London, England)
|December 22, 2004
PubMed

Insights

The enzyme-linked immunospot assay (ELISPOT) shows higher sensitivity for diagnosing childhood tuberculosis than the skin test. Combining ELISPOT with the skin test improves diagnostic accuracy in high-prevalence areas.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Pediatrics

Background:

  • Childhood tuberculosis diagnosis is challenging due to non-specific symptoms and low sensitivity of current tools.
  • Overdiagnosis is common, and HIV co-infection complicates diagnosis and treatment.
  • Paediatric tuberculosis is an increasing global health concern, particularly in high-prevalence regions.

Purpose of the Study:

  • To evaluate the clinical utility of the enzyme-linked immunospot assay (ELISPOT), a rapid T-cell-based blood test for Mycobacterium tuberculosis infection.
  • To compare the diagnostic performance of ELISPOT with the tuberculin skin test (TST) in African children with suspected tuberculosis.

Main Methods:

  • A prospective, blinded study involving 293 African children with suspected tuberculosis in a high HIV prevalence area.
  • Children underwent clinical assessment, ELISPOT, and TST.
  • Test results were compared against final clinical and microbiological diagnoses.

Main Results:

  • ELISPOT sensitivity was 83%, significantly higher than TST sensitivity (63%).
  • TST sensitivity was notably lower in children under 3 years, with HIV co-infection, or malnutrition.
  • ELISPOT performance remained robust across these subgroups, and combined testing achieved 91% sensitivity.

Conclusions:

  • ELISPOT demonstrates superior diagnostic sensitivity for childhood tuberculosis compared to the TST.
  • ELISPOT is less affected by factors common in developing countries, such as HIV co-infection and malnutrition.
  • The combination of ELISPOT and TST offers clinically valuable diagnostic sensitivity for suspected paediatric tuberculosis in African children.
Abstract

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